Ferrante Marc, de Hertogh Gert, Hlavaty Tibor, D'Haens Geert, Penninckx Freddy, D'Hoore Andre, Vermeire Séverine, Rutgeerts Paul, Geboes Karel, van Assche Gert
Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Gastroenterology. 2006 May;130(6):1595-606. doi: 10.1053/j.gastro.2006.02.025.
BACKGROUND & AIMS: Early ileocolonoscopy allows detection of recurrence after surgically induced remission of Crohn's disease (CD). Unequivocal histologic markers predicting recurrence have not been identified. We assessed the predictive value of neural lesions for early endoscopic CD recurrence and long-term reintervention risk.
Ileocolonic resection specimens from 59 patients with CD and 21 control patients were histologically scored for typical inflammatory bowel disease lesions, neural hypertrophy, and presence and severity of inflamed ganglia and nerve bundles. Endoscopic recurrence was determined at 3 months in all patients and at 1 year in 32 patients as part of 2 prospective clinical trials.
Myenteric plexitis of the proximal resection margin was present in 32 patients with CD (54%) in absence of surrounding inflammation. Patients with this feature had a higher endoscopic recurrence (Rutgeerts score >/=2) at 3 months (75% vs 41%; odds ratio, 4.36; 95% confidence interval, 1.44-13.23; P = .008) and at 1 year (93% vs 59%; odds ratio, 9.80; 95% confidence interval, 1.04-92.70; P = .041) and had a trend toward an earlier reintervention (mean, 7.00 vs 5.30 years; P = .174). The severity of myenteric plexitis in the proximal resection margin correlated with the severity of endoscopic recurrence at 3 months (r = 0.334, P = .010) and 1 year (r = 0.560, P = .001). Myenteric plexitis was the only consistent predictor of endoscopic recurrence.
The presence of myenteric plexitis in proximal margins of ileocolonic resection specimens is predictive of early endoscopic CD recurrence.
早期回结肠镜检查有助于在克罗恩病（CD）手术诱导缓解后检测复发情况。目前尚未确定明确的预测复发的组织学标志物。我们评估了神经病变对早期内镜下CD复发及长期再次干预风险的预测价值。
对59例CD患者和21例对照患者的回结肠切除标本进行组织学评分，评估典型炎症性肠病病变、神经肥大以及发炎神经节和神经束的存在及严重程度。作为两项前瞻性临床试验的一部分，所有患者在3个月时确定内镜复发情况，32例患者在1年时确定内镜复发情况。
32例CD患者（54%）的近端切除边缘存在肌间神经丛炎，且无周围炎症。具有此特征的患者在3个月时内镜复发（ Rutgeerts评分≥2）的比例更高（75% 对41%；优势比，4.36；95%置信区间，1.44 - 13.23；P = 0.008），在1年时也是如此（93% 对59%；优势比，9.80；95%置信区间，1.04 - 92.70；P = 0.041），并且有更早再次干预的趋势（平均，7.00对5.30年；P = 0.174）。近端切除边缘肌间神经丛炎的严重程度与3个月时（r = 0.334，P = 0.010）和1年时（r = 0.560，P = 0.001）内镜复发的严重程度相关。肌间神经丛炎是内镜复发的唯一一致预测指标。
回结肠切除标本近端边缘存在肌间神经丛炎可预测早期内镜下CD复发。
